Risk Factors Of Cerebrospinal Fluid Leakage In Lumbar Surgery And The Application Value Of Hyperplastic Bone Knife

Objective: To analyze the risk factors of cerebrospinal fluid leakage(CSF)in the posterior approach of lumbar spine,and to explore the effect of ultrasonic scalpel on CSF leakage in lumbar surgery.Methods:(1)A total of 845 patients who underwent lumbar spine surgery at Shengjing Hospital affiliated to China Medical University from January 2016 to December 2019 were collected.The cerebrospinal fluid leakage was divided into leakage group(67 cases)and non-leak group(778 cases).The age,sex,course of disease,operation time,decompression segment,body mass index(BMI),smoking history,drinking The correlation between 17 indicators including history and cerebrospinal fluid leakage;after assigning statistically significant indicators,the risk factors and protective factors of cerebrospinal fluid leakage were further screened by logistic regression analysis.(2)The effect of lumbar spine surgery on the cerebrospinal fluid leakage was reviewed retrospectively.In the case of the same type of surgery and decompression segments,the patients were divided into the ultrasonic bone knife treatment group(150 cases)and the control group(150 patients)based on whether the ultrasonic bone knife was used for decompression.Incidence rate and related indicators.Result:(1)Comparison of clinical data between the two groups of patients showed that of the845 patients undergoing lumbar surgery in this study,a total of 67 cases had cerebrospinal fluid leakage,the incidence was 7.93%;univariate analysis showed that the two groups of patients in The course of disease,type of disease,type of surgery,dural adhesion,decompression mode,decompression segment have statistically significant effects on cerebrospinal fluid leakage(P <0.05);gender,body mass index,combined There were no statistical differences between the two groups of diabetes,hypertension,operation time,previous trauma and traumatic treatment,implantation of internal fixators,and implantation of fusion devices(P> 0.05).Multivariate Logistic regression analysis showed that age,smoking history,drinking history,spinal stenosis,degenerative scoliosis,revision surgery,dural adhesions,andmulti-segment decompression were risk factors for cerebrospinal fluid leakage after lumbar spine surgery(OR>1,P<0.05);the course of disease and decompression of ultrasonic bone knife were protective factors of cerebrospinal fluid leakage after lumbar spine surgery(OR<1,P<0.05).(3)A retrospective study of ultrasound osteotomy decompression showed that 8 of the150 patients in the ultrasound osteotomy group had cerebrospinal fluid leakage,a rate of 5.33%,and 21 of 150 patients in the control group had cerebrospinal fluid leakage The rate was 14.00%.The operation time,the length of hospital stay,and the total bleeding volume of the ultrasonic osteotomy group were lower than those of the control group(P <0.05),and the JOA score was higher than that of the control group(P <0.05).The levels of TNF-and IL-8 in the group were lower than those in the control group(P <0.05).Conclusion:(1)Analysis of risk factors for cerebrospinal fluid leakage in lumbar spine surgery found that age,smoking history,drinking history,dural adhesions,revision surgery,spinal stenosis,degenerative scoliosis,and multi-segment decompression were risk factors for cerebrospinal fluid leakage in lumbar surgery;ultrasound Bone knife decompression and disease duration < 1year are the protective factors of cerebrospinal fluid leakage in lumbar spine surgery.(2)Retrospective studies suggest that ultrasound osteotome decompression can reduce the incidence of cerebrospinal fluid leakage in spinal surgery,shorten the operation time,hospital stay,reduce the amount of surgical bleeding and control inflammatory reactions,and can better improve the postoperative status and prognosis of patients.